Analysis: most commonly associated with cheating athletes, steroids occur naturally in our bodies and play an important role in modern medicine

By Dipali Ahuja, University of Limerick; Laurie Ryan, University of Limerick and Emer Browne, TCD

"And the winner is…!" - or is it? The prevalence of doping at major sporting events such as the Olympics has called into question the rightful winner of many competitions. In the 2012 European Athletic Championships women's 1500 metres final, the first, second, third and fourth placed athletes subsequently faced bans for testing positive for using performance enhancing substances. The athlete who originally finished fifth, Nuria Fernández, was eventually deemed the rightful winner.

The most commonly used class of performance enhancing substances are steroids. It's a word which evokes images of fallen athletes such as Lance Armstrong and Ben Johnson. However, what many people may not know is that steroids occur naturally in our bodies and play an important role in modern medicine. 

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Steroids are hormones produced by the body to help cells, tissues and organs function. Our body's naturally occurring steroids are created using cholesterol as a starting material. This occurs mainly in the adrenal glands, which are located just above the kidneys.

There are two main classes of steroids: corticosteroids and androgenic steroids. Corticosteroids control many natural processes in our bodies such as responding to inflammation and regulating salt and water balance. They can be produced naturally in the body or synthetically manufactured. Sometimes the body does not produce enough corticosteroids, such as in Addison's disease, and taking synthetic steroids can be lifesaving. Similarly, steroids are often prescribed by doctors to help patients to recover from illness. 

The use of corticosteroids as medicines is only possible thanks to the work of several medicinal chemists who enabled the cost-effective synthesis of cortisone. When cortisone was first synthesized in the 1940s, it required the bile of 2,500 cows as a starting material, before a complicated 36 step chemical process was applied to produce 15 milligrams of cortisone (which is only approximately 0.5% of a teaspoon!).

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The discovery of a new starting material, diosgenin, from the Mexican yam (a vegetable from the sweet-potato family), dramatically reduced the cost of producing cortisone and enabled its use as a medicine. Many other medicines have since been developed in the corticosteroid family including; inhalers to treat asthma, tablets for inflammatory conditions and creams to treat psoriasis.

The other major class of steroids are the androgenic steroids, also known as sex steroids. These include the female sex steroids like estrogen and progesterone and the male sex steroid testosterone. Just like the corticosteroids, androgenic steroids are produced in our bodies but sometimes we use synthetic versions of the androgenic steroids medicinally to treat a wide variety of conditions.

The combined oral contraceptive pill used by millions of women worldwide, for example, is a combination of a synthetic estrogen and a synthetic progesterone. The combination of these steroids at the right doses inhibit ovulation and thus prevent pregnancy. Interestingly, progesterone may also be used to support pregnancy during fertility treatment, but at a different dosing regimen.

From RTÉ Radio 1's Ryan Tubridy Show, strongman James Fennelly on why he stopped using steroids

While the use of female sex steroids for medicinal purposes is widespread, the use of testosterone is more often associated with illicit use. Testosterone is known as the primary male hormone: when boys go through puberty, testosterone causes a deepening of their voice and growth of body hair. But the effect that testosterone has on increasing bone and muscle mass is often the reason why it is abused. These are known as anabolic effects, and where the term "anabolic steroid" comes from.

While testosterone is used medicinally by men who don’t produce enough testosterone naturally, its abuse dates back to when it was first synthesized in 1935. During the Second World War, it was discovered that malnourished soldiers treated with artificial testosterone gained weight and displayed improved performance.

Using testosterone to improve athletic performance dates back to 1954, when the Russian weightlifting team injected themselves with testosterone prior to the World Weightlifting Championship in Vienna. Seeing the advantage this substance gave to the Russian athletes, American doctor John Ziegler returned to America and started work developing a novel anabolic steroid. This culminated in the creation of methandrostenolone, which was sold under the trade name "Dianabol". With this, the era of anabolic steroid use in sports began.

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Aware that the use of these substances was resulting in an uneven playing field, the International Olympics Committee (IOC) banned the use of performance enhancing substances in 1967. However, it wasn’t until 1976 that a reliable test that could detect anabolic steroid use was developed.

Despite the reputational damage athletes faced if caught, anabolic steroid use was widespread in elite sport in the 1980s and 1990s. As well as putting their careers at risk, athletes using anabolic steroids put their health at risk. This is because prolonged, unsupervised use of anabolic steroids can result in side effects such as liver and heart disease, infertility, depression, aggression, acne and hair loss. Moreover, as anabolic steroids are commonly bought on the black market, the quality and safety tests that are required for legitimate medicines are unlikely to have been performed.

Ultimately, from a medicinal perspective, steroids are an excellent resource that have transformed modern medicine. However, the medicinal use of steroids means that you have been advised by a professional to use a specific steroid dose for a particular amount of time to treat a specific condition. Furthermore, when you get a steroid from the pharmacist, its quality and efficacy have been tested under stringent regulations.

From RTÉ Radio 1's News At One, RTÉ Investigates Barry O'Kelly on the illegal trade in steroids which can lead to catastrophic health consequences for users

Problems occur when healthy individuals buy unregulated products, which are labelled as steroids, on the black market. In this scenario there is no quality assurance and no medical professional to monitor side effects. Under these conditions, steroids can be dangerous. 

This doesn’t appear to have stopped the influx of illegal anabolic steroids onto the Irish market, as 98,055 anabolic steroid dosage units were detained in 2018 by the Irish regulatory body for medicines, the HPRA. In light of this, there is a greater need to educate the public about the dangers of abusing steroids and how we should treat them with respect as medicines. 

Dipali Ahuja is a PhD researcher with SSPC, the SFI Research Centre for Pharmaceuticals, at the University of LimerickLaurie Ryan is a PhD researcher with SSPC at the University of LimerickEmer Browne is a pharmacist and PhD researcher with SSPC at TCD.

The views expressed here are those of the author and do not represent or reflect the views of RTÉ